经皮脾静脉成形术治疗胰源性门静脉高压症  

Percutaneous splenic phleboplasty for the treatment of pancreatic portal hypertension

作　　者：朱军[1] 徐晓茜[2] 罗剑钧 林春兴 陈忠华[1] 罗咏萍[1] 蒋晓忠[1] 黄勇[1] 曹跃勇[1] ZHU Jun, XU Xiaoqian, LUO Jianjun, LIN Chunxing, CHEN Zhonghua, LUO Yongping, JIANG Xiaozhong, HUANG Yong, CAO Yueyong.(Department of Interventional Radiology, Yibin Municipal Second People＇s Hospital, Yibin, Sichuan Province 644000, Chin)

机构地区：[1]宜宾市第二人民医院放射介入科,四川644000 [2]宜宾市疾病预防控制中心门诊部 [3]复旦大学附属中山医院介入科

出　　处：《介入放射学杂志》2018年第5期415-418,共4页Journal of Interventional Radiology

摘　　要：目的探讨经皮脾静脉成形术治疗胰源性门静脉高压症(PSPH)的可行性及近期临床效果。方法回顾性分析2014年11月至2016年5月采用经皮经肝门静脉穿刺脾静脉成形术治疗的4例PSPH伴消化道出血患者。通过比较患者术前和术后12个月脾功能亢进指标、曲张静脉影像学改变、脾静脉支架通畅度等情况以及有无复发出血,评价该方法近期临床疗效。结果 4例患者成功完成经皮经肝门静脉穿刺、脾静脉球囊扩张及脾静脉支架植入术,术中、术后未出现严重并发症。术后12个月内所有患者均无消化道出血复发,平均血小板计数由术前68.7×10~9/L升至92.4×10~9/L。术后12个月胃镜和增强CT显示胃底部静脉曲张程度较术前明显减轻,静脉红色征消失,脾静脉支架通畅率为100%。结论经皮脾静脉成形术治疗PSPH的近期疗效确切,尚需进一步扩大患者数进行远期随访研究。Objective To evaluate the feasibility and short-term clinical efficacy of percutaneous splenic phleboplasty in treating pancreatic sinistral portal hypertension（PSPH）. Methods The clinical data of 4 patients with PSPH complicated by hemorrhage of digestive tract, who were treated with percutaneous splenic phleboplasty through transhepatic portal vein puncture during the period from November 2014 to May2016, were retrospectively analyzed. The preoperative and 12-month postoperative hypersplenism indexes,the imaging changes of varicose veins, the patency of splenic vein stent, the presence or absence of recurrent bleeding, etc. were recorded, based on which the short-term clinical curative efficacy was assessed. Results Successful transhepatic portal vein puncture, balloon dilation of splenic vein and splenic vein stent implantation were accomplished in all 4 patients. No serious complications occurred during and after operation process. No recurrence of gastrointestinal bleeding was observed within 12 months after treatment. The mean platelet count increased from preoperative 68.7 ×10~9/L to postoperative 92.4 ×10~9/L. Gastroscopy and contrast-enhanced CT scan performed at 12 months after treatment showed that the degree of varices in the fundus of stomach became obviously alleviated when compared with the preoperative findings, the previous venous red sign disappeared, and the patency rate of splenic vein stent was 100%. Conclusion For the treatment of PSPH, percutaneous splenic phleboplasty has definite short-term efficacy, although long-term follow-up studies with large sample are needed to further verify its curative effect.

关 键 词：胰源性 门静脉高压症 经皮脾静脉成形术 静脉曲张 

分 类 号：R575.2[医药卫生—消化系统]